Acne

Unfortunately acne can have long term effects. The most unsightly by-product of acne is the scarring that it can leave behind. Even minor outbreaks of inflammatory acne can result in scars if you’re predisposed to scaring and they are not always easy to treat. Scaring can result from severe nodular acne that occurs deep in the skin and also from less inflamed lesions. These scars can take on a number of different forms that include holes, pits, or craters in the skin and also flat or bulging scars that occur in different colors.

The good news is that more acne scar treatments are becoming available, some of which are showing positive results. These are outlined in this article.

Do you need Acne Scar Treatment?

You should not go ahead with any costly treatment for acne scaring, particularly surgery, until your acne has completely gone. Acne scar treatment can be expensive so you need to make sure you do not go through the expense and trouble of undergoing procedures multiple times.

Some acne scar treatments can result in more scaring particularly if you are prone to hypertrophic or keloid scars. Hypertrophic and keloid scars are harder to get rid of and occur more in darker skinned people. Hypertrophic scars occur when the wound heals to become red, raised and itchy for a few months but will then resolve to become flat and pale. A keloid is similar but the scar continues to grow encroaching upon normal tissue and may need specific treatment.¹

These scars tend to occur on people that scar easily and produce too much collagen. Treatment for keloid or hypertrophic scars can involve having them shaved flat or cut out by a dermatologist or surgeon. You would need to make sure that this procedure is right for you as there is a risk of further scaring.

The type of acne scar treatment you decide upon should be the one that is best for you in terms of your type of skin, the cost of the acne scar treatment, and what you want it to accomplish.

Acne Scar Treatment Options

There are numerous acne scar treatment options available that range from surgical treatment to oral and topical treatments (applied to the skin). Some of these treatments include skin resurfacing techniques that use lasers, dermabrasion which removes the top layers of skin, surgical excision, soft tissue fillers and scar revision.

Acne Scar Laser Treatment
If conventional acne therapies have failed an alternative treatment for combating Acne scarring can involve the use of lasers and lights. Lasers can be tuned to target specific structures under the skin. They can penetrate hair follicles, sebaceous glands and the P. acnes bacteria. Some lasers are used to treat acne itself. They can also be used to stimulate collagen production which helps to reduce the appearance of acne scars. By heating dermal collagen, they help to ‘tighten’ the dermis and this results in less visible scarring

Laser Skin Resurfacing
There are many different types of laser used to resurface the face but there are two main types – Ablative and non-ablative lasers. Which one is used will depend very much on the depth of the scaring.

Ablative lasers carry the risk of further scaring because the skin is injured and unprotected tissue is exposed. These lasers are usually reserved for the deeper scars.

Non-ablative lasers have become popular because they have the ability to promote collagen growth beneath an acne scar without causing an external injury such as to the epidermis. Non-ablative lasers include infrared lasers, N-Lite lasers and the Fraxel laser. Non-ablative lasers are not so effective for deep, depressed, craterlike scars. However these lasers are less likely to result in further scaring and the recovery time is quicker than with ablative lasers.

Laser resurfacing treatment can take place in the Clinique and usually two or three sessions are required. For a thorough ‘full-face’ resurfacing this can cost between $3,000 and $8,000 or more.
For improved results other surgical treatments for acne scars are combined. This surgical treatment will occur a few weeks before laser resurfacing is performed.

Surgical Acne Scar Treatment
This can involve removal of the scar with a tool that punches out small slices of the skin. The scar can be removed and replaced with skin harvested from elsewhere on the body and is successful for treating deep scars. Surgical removal is most successful when used with a resurfacing technique such as laser resurfacing. The price of the procedure varies depending on the number of grafts but usually costs around $50 to $150 per graft and between $1,000 and $2,500 for a session.

Another surgical treatment for acne scars is remodeling scared tissue by using a scalper or needle to remove and separate the scared tissue from the unscarred skin, elevating the skin to make it more even. It allows the blood to pool under the affected area and helps to induce new collagen formation. Once the skin has leveled laser resurfacing, microdermabrasion or chemical peels can be used. This procedure is useful for indented scars that result from scar tissue holding the skin down.

Dermal Fillers
Dermal fillers which include Collagen, Retylane or Hylaform injections can work for certain scars such as the shallow scars with sloping edges. However they are unsuitable with most acne scars and usually only offer a temporary solution as the dermal filler is usually gradually broken down by the body.

These dermal fillers can be injected into the depressed area of the scar to elevate it at the level of the surrounding skin. You should be wary of using the bovine collagens Zyderm and Zyplast as they can result in an allergic reaction in some people. Dermal fillers are best used in combination with other surgical treatments

The cost of a dermal filler can vary significantly and will depend on factors such as the type of dermal filler used and the quantity that is injected. Prices range from $400 to over a $1000.

Dermabrasion and Microbrasion
Dermabrasion and Microbrasion involve removing the top layer of skin. A treatment that has been around for many years dermabrasion is used mainly for shallow scars.

The difference between dermabrasion and microbrasion is that a qualified dermatologic or plastic surgeon should perform dermabrasion whereas microbrasion can be carried out by anyone. Another difference is the price. Dermabrasion costs thousands of dollars whereas Microbrasion only hundreds. Dermabrasion has largely been replaced by laser resurfacing as it is less affective and may make some scars more noticeable such as depressed fibrotic and ice-pick scars.

Prevention Better than Cure

Prevention is often better than cure and oral antibiotics and intralesional cortisone injections, as described below can attack the problem before a scar forms.

Oral Antibiotics
Oral antibiotics are not so much of an acne scar treatment as a preventative measure. Powerful antibiotics such as tetracyclines will get the papules and nodules under control and help prevent post-inflammatory hyperpigmentation which can cause the hypertrophic and keloid scars that are more difficult to get rid of.

Intralesional Cortisone Injections
Cortisone injections, sometimes referred to as steroid shots or cyst injections, involve injecting a dilute corticosteroid directly into the blemish. The cortisone should reduce inflammation and after a few days the blemish shrinks. They lessen the chance of developing scars, particularly if you are prone to scarring. They are particularly effective at treating papules, cysts and nodules.

While there are few side-effects to this treatment if the concentration of cortisone is not correct this can cause depressions, or pitting of the skin in the area.²

Acne Scar Treatment Risks

Treatments are sometimes carried out by inadequately trained practitioners, sometimes leading to disfigurement. Ensure you find an adequately trained practitioner.

Sometimes treatment can lead to more scaring if you have a predisposition to developing hypertrophic or keloid scars.

Acne scar treatments can be expensive so ensure you weigh up the pros and cons by talking to a reputable and experienced physician.

1. Scars & Keloids, The British Association of Aesthetic Plastic Surgeons [↩]
2. Levine RM, Rasmussen JE. Intralesional corticosteroids in the treatment of nodulocystic acne. Arch Dermatol. 1983 Jun;119(6):480-1. [↩]

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